Psychotherapy or “talk therapy” is an unethical, damaging practice with conflicts of interest and perverse incentives at its foundation. The problems with therapy can be put into roughly the following categories: paradoxical and dehumanizing structure of therapy relationships, lack of scientific validity, lack of transparency and consumer protections, and harmful outcomes.

Paradoxical Asymmetrical Structure of Therapy Relationships

The structure of therapy is antithetical to and models the opposite of goals one would hope to achieve in real life/relationships:

2) Goal: authenticity, e.g., connection based on both people revealing their true selves and developing mutual love and respectTherapy: artificial relationships based on payment, theories, labels/assessment/judgement, contrived boundaries, and one-way intimacy

8) Goal: “Always act in such a way that you treat humanity, whether in your own person or in the person of another, at the same time as an end-in-itself and never merely as a means.” — Immanuel KantTherapy: Dehumanizing instrumental relationship in which the therapist uses the client as a means to profit and gratification by withholding information needed for a client’s true informed consent. Therapist belief that she knows best and that the end justifies the manipulative means.

10) And the list of antitheses between our goals and what therapy models goes on . . .

We create patterns, habits, and ways of being — we create our worlds — through our actions and interactions with others. To the extent that therapy creates a world of artificial imbalanced relationships, inequality, non-mutuality, one-way intimacy, one-way exposure and concealment/voyeurism, “patient” status/distancing labels/disempowering identities/assessments, paternalism, authority, subordination, and co-dependence, it may be far more harmful than the original worldview that a client was trying to get a new perspective on in the first place. Many clients end up feeling violated, exploited and used, and much worse off than they were before therapy.

The therapist-client relationship is equally harmful to therapists. While the feelings of power, control, and superiority may temporarily alleviate a therapist’s narcissistic wounds and fears, the unbalanced dynamics actually perpetuate and reinforce the painful condition (lack of capacity for mutuality, trust, equal vulnerability, being seen, etc.) that often motivates a therapist to become a therapist in the first place.

Lack of Scientific Validity and Justification

In addition to the dehumanizing structure of therapy, there’s the validity problem. There are no scientifically valid, replicated, controlled clinical trials showing that psychotherapy is any more efficacious than talking to friends or life coaches, motivational speakers, gurus, psychics/palm readers, cult leaders, mystics, and other snake-oil vendors that prey on vulnerable clients — and have a following of enthusiasts with anecdotes who extol their benefits.

Moreover, for the anecdotes/cases in which therapists claim that they have helped, they are unable to articulate why or how what they did altered the brain or helped. Until therapists can clearly articulate what processes/methodologies and what types of client/therapist relationship matches cause benefits and which cause harm, and why, they are not in a position to navigate away from harming clients. Without understanding why or how they help in some cases and hurt in other cases, they are not in a position to adhere to scientific and ethical principles, including “first do no harm.” And until they have that sorted out, it is irresponsible and unethical for them to experiment on clients — collecting lots of money and spending lots of time, figuring that it may work or may harm them some of the time. “Treatments” need to be tested, understood, and validated *before* being tried out on the public.

In accordance with basic principles of reason, the fact that there exist (unfalsifiable) anecdotes/cases in which there are perceived benefits resulting from therapy does little to justify the practice in light of the fact there are also anecdotes/cases in which there are perceived harms resulting from therapy. The burden of proof lies with she who asserts a positive. In this case the burden of proof lies with she who asserts that therapy is justified, not with its critics. It is not the critics’ job to prove the null hypothesis. The burden is to show that the practice of therapy is justified in spite of the fact that there will be collateral damage and some people will be harmed. Until this burden can be met by means of scientific demonstration and ethical argument (it’s not merely a utilitarian numbers game; the end doesn’t justify the means), the practice cannot be viewed as justified. The number of anecdotes about people who claim to have benefited from a practice is irrelevant in the face of dehumanizing or unethical means to that “benefit.” (Analogy: lots of people may “benefit” from the food and shelter provided by slavery, but that does not make slavery a justified means of providing that benefit. An unequal, power-imbalanced slave-slave-owner relationship without fully informed informed consent is an unethical way of relating to our fellow humans regardless of the number who may “benefit.”)

Lack of Transparency and Consumer Protections

Therapists often fail to acknowledge or warn clients about the potential harm that may result from therapy. The practice is currently so shrouded in secrecy, and the limited data behind it is riddled with so many shady research practices (e.g., using statistical methods that generate false positives, hiding data that didn’t show the desired outcome, the file-drawer effect, publication bias, selection bias, confirmation bias, allegiance effects, demand characteristics, Hawthorne effects, failure to use active controls that control for expectations, etc.), that many therapists themselves aren’t even aware of the potential side-effects and risks. They are notoriously blind to their own weaknesses and failures, and subject to the “Lake Wobegon Effect” when it comes to their own practice — playing up anecdotes of treatments that worked and blindly disregarding the clients that they hurt.

This needs to change. Consumers deserve better. In order for consumers to have the opportunity to give true informed consent, therapists have to disclose their efficacy/failure rates and Important Safety Information up front, including proposed methodologies, perceived mechanism of action, clinical trial results (or lack thereof), rates of adverse events and side effects, etc. And there should be an independent regulatory board, like the FDA, to which consumers can report adverse events and side effects of therapy so that the most harmful therapists can be pulled from the market, or at least reported in a database available to consumers wishing to make informed decisions. With the current lack of clinical standards, consumers bear the burden of evaluating their therapists, which can be extremely time-consuming and expensive. Those in crisis without the luxury of time and money stand a strong chance of suffering from a poorly matched therapist.

Harmful Outcomes

Many clients are harmed, emotionally abused, emotionally raped, retraumatized, or mistreated in therapy, and end up much worse off than they were before therapy. Despite the possibly good intentions of the therapist, the paradoxical asymmetrical structure of the relationship discussed above is a dehumanizing framework that creates a situation ripe for exploitation and harm. Additionally, there is no such thing as a human being (or therapist) who can adopt a purely unbiased, value-free, neutral position. Many, if not all, therapists enter the therapy relationship with their own baggage lurking in their subconscious, which infects the nature of the inquiries, interpretations, and “insights” that are discussed. Since it is very easy and natural for a client in a vulnerable and naively trusting position to be influenced or to acquire false memories based on even subtle suggestions/inquiries from a therapist who is assuming the role of “expert” or “professional,” this creates a potentially dangerous situation for clients. Add to this the fact that, whether conscious or not, the incentives of the therapist (keep clients/job security/feel important) are not aligned with the incentives of the clients (become healthy/happy/therapy-free), and that diminishing the strength of the client’s outside personal relationships increases the client’s relative reliance on the therapist, and the potential danger for the client may be inescapable. In fact, history has shown that therapy has destroyed many family relationships, marriages, and friendships.

Therapy should not be the mysterious hit-or-miss endeavor that it is. The costs in terms of time, money, and potential emotional damage are too high. Again, dismissing emotionally harmed clients as collateral damage for the sake of some who believe it’s helpful is unethical and unacceptable.

Unethical Practice

The unethical nature of psychotherapy has been discussed above in terms of the harmful paradoxical asymmetrical structure of the relationship, the unauthorized human experiments involved in practicing therapies that have not been previously validated in replicated scientific trials, the failure of therapists to provide the full disclosures required for true informed consent, and the unjustified risk of harmful outcomes. Given these features of the practice, psychotherapy belongs in the dust bins of history along with lobotomies, slavery, eugenics, Nazism, gay conversion therapy, Native American genocide, repressed memory therapies, colonization of indigenous people, female genital mutilation, critical incident stress debriefing, Stalinism, holding attachment therapy, Chinese foot-binding, Salem witch trials, apartheid, APA-endorsed Guantanamo torture, and other horrors that large populations once bought into.

Recommendations

After seeking the help of a medical doctor for biological/neurological concerns, the best thing people who need help can do is to stop wasting their precious time and money on psychotherapy, and seek out healthier, safer, and cheaper alternatives that foster genuine two-way relationships, generosity, self-esteem, wholeheartedness, and growth, such as: joining a support group founded in *mutual* give-and-take relationships with equal openness/equal emotional exposure, talking with friends/family/significant others (and listening in return), cultivating new friends through hobbies or meet-up groups based on common interests/causes/needs, participating in peer-run support services, getting a puppy, doing volunteer work, meditating, exercising, dancing, reading self-help books, reading literature, connecting with people who have earned your trust, writing your feelings down in a journal, getting massages, talking to a pet or volunteering at an animal shelter for 45 minutes per week (the length of a therapy session), listening to music, going to concerts, going to comedy shows, creating or contemplating art, doing yoga, jogging, hugging, taking nature walks, creating a ritual of having tea at your favorite cafe for 45 minutes per week, reaching out to help other people, engaging in random acts of kindness, and more.

We *all* have the ability to do our part to make this world a more compassionate and sane place to be. When we try to relegate humane support to paid workers (such as the psychotherapy industrial complex with labels and incentive structures that conflict with lasting health and flourishing), we chip away at the humanity of us all. We are all in this together, and we can do better.

I don’t think therapy can meet any of the goals you’ve described, and inasmuch as most of what’s available to consumers today is concerned, I agree with your analysis.

However, I think psychology has the potential to be useful. There’s interesting stuff happening on the research side of things. If therapists of the future were to limit themselves — and their authority — to the application of validated techniques for modifying cognitive patterns identified as destructive, and very specific, contemporary behaviours (vs whatever happened with mother and father decades ago), at least some people might be assisted in the relief of overwhelming and destructive negative emotions.

An example of a treatment known to be efficacious today would be exposure therapy for phobias. Perhaps in a few decades, similarly valid, non-pharmalogical techniques may emerge for, e.g., impulse control (which could conceivably benefit people with, e.g. addictions). All this depends on how these experiences are conceptualized, of course, and many organizations have already discounted the current DSM, and are looking instead to alternative, research-driven classifications.

I believe neuroscience has the potential to redefine both some of the problems of life, and the most effective ways of approaching them. Because yes, life brings us all sadness, and for the lucky, friends and family to help us bear it. But some people really are incapacitated by something beyond ordinary sadness, and have no one to love them out of it*.

The way therapy is delivered today absolutely lends itself to the abuses you describe. But, what if the delivery of the findings of psychological science were done by teacher-facilitators? Trainers, if you like, of techniques that actually worked to support the achievement of particular, short-term goals? And not in a black box, but in a public space, in consultation with other health care professionals, with real accountability for successes and failures?

*I do not suggest these teachers of the future could give them love, but strategies to manage its absence, and to live a little better until it comes, if it does.

Without reading every word, I think you make some points but don’t see research as 80% of the issue. It would just help so there’d be less quacks. Some ppl may truly benefit from ethical measures that may be slightly out of the box.I can talk all I want & make changes, but there needs to be something more.

Thank you for this. I am a counsellor in the UK who has been on the receiving end of great therapy, and abusive therapy. The reality of this shadow side of my profession should come out of the shadows, to empower clients and give them real choices. Have Tweeted this.

oh how this site needs to be read, re-read and read again and again. it SO needed to be written. you’ve pointed out everything that i, a therapy dropout for many years, finally realized. the harm that was done me by this fraudulent crap is the worst abuse i have endured in my adult life. i thought i needed it, when it was actually the last thing i needed. i have been therapy-free for many years and they have been the best years. i only wish i had wised up sooner, because some of therapy’s damage lingers on like a bad tune that keeps playing in your mind over and over. i cant believe how they get away with the stuff they get away with. your proposed alternatives to therapy are all marvelous and i am involved in most of them. please keep up this very important work.

This is a really great post. I’ve been thinking about these things lately as well. I started therapy almost a year ago, and although I understand the intention of the ‘blank screen’ model, it always seemed unnatural and inhuman in a way that made me wonder how it could be healthy in the long run.

A responsible client (one who is open to change, respects the therapeutic boundaries and trusts the abilities of the therapist to be a blank screen) shouldn’t care about the therapist’s feelings in the course of a session, as long as s/he stops talking when the paid time is up. How is this good training for life in any way?

This client should say whatever s/he feels, whether it’s appropriate or not. The client is not supposed to think “What if saying this would be cruel, or seductive” before speaking? If s/he doesn’t express these feelings, then s/he’s repressing. If s/he does try to tap into his/her ‘actual’ feelings, then s/he’s acting out a ‘transference’ and must understand that it’s not real and shouldn’t feel the need to act on it, though those feelings should somehow be ‘explored’ within the confines of this one-sided relationship, before anywhere else (where real human interaction would naturally, most likely, give us more realistic feedback).

I thought I was repressed, and that therapy would help me open up. Instead, it seems to have simply re-habituated me into neurotic thoughts of ‘real’ and ‘not real’, ‘appropriate’ and ‘inappropriate’.

A responsible therapist (one who tries to be a blank screen, maintains therapeutic boundaries and trusts that the client is open to change) should, for a small fee, become inhuman (or somehow superhuman) for a period of time. http://www.davidsmail.info/talk95a.htm

I don’t think I could become a therapist, not because I don’t want to help people, but because as a human being, I think the biggest mistakes I’ve ever made came from the ‘blank screen’ attitude. “I am whatever you think I am”. How is this a healthy job?

Understanding that we are constantly projecting and projected upon is a worthy goal, but actually becoming a blank screen or negating reality as mere projection are unhealthy extremes, I think. These roles of client and therapist are instructive, but only for their basic absurdity.

My experience was with a fairly nice person who seemed to mean well and yet I feel profoundly damaged by therapy. I feel like my life has been stolen from me. I have almost no ability to trust people anymore. I can only appreciate people. I think it is the structure of the paradigm that causes the problem. I have also worked in the field with the intention of becoming a psychotherapist. I would never do it now.

I’m so sorry for your experience, and completely understand. You are not alone. I added more thoughts on how the therapy industry can be devastating to a person’s ability to trust in item 6 on the media and commentary page here: https://trytherapyfree.wordpress.com/commentary/

I admire your integrity in refusing to join the fraudulent pseudoscientific psychotherapy industry. It is sad to hear stories from some people who can see the harm (and waste) caused by the industry, but selfishly or lazily look the other way and press forward perpetrating it.

If anyone is still reading this post, I would like to offer my profound apologies for the pain that my profession has caused those of you who have commented here. I’m a psychologist myself and I try very hard to make sure people are in a better place for having worked with me than they were previously, but I know that can’t always be the case, and that makes me feel badly.

I might point out, however, that the same holds true for every profession, blue-collar and white-collar alike. The reason is because we’re all human. We all screw up sometimes. No profession is harmless because every profession is comprised of flawed humans.

I might also point out that there are times when the shoe is on the other foot and the therapist has to get professional help from colleagues in order to address and heal from the damage caused by a client. We just don’t tell you about our issues because your session is about you, not about us.

Thank you for your apology on behalf of the psychotherapy industry to all of the people it has hurt.

The problem here is not flawed people in an honest profession, but rather people in a flawed, dishonest profession. (Further, a profession that hurts people’s emotional well-being is far more reprehensible than one that hurts people’s financial well-being.)

The practice of psychotherapy belongs in 20th century history books. We can do better now.

“We just don’t tell you about our issues because your session is about you, not about us.”

That, in a nutshell, is the problem. If it’s not a free-flowing give and take, then it’s not a natural relationship, and, IMHO, will ultimately be more harmful than helpful, however well-intentioned it may be.

“My experience was with a fairly nice person who seemed to mean well and yet I feel profoundly damaged by therapy. I feel like my life has been stolen from me. I HAVE ALMOST NO ABILITY TO TRUST PEOPLE ANYMORE. I CAN ONLY APPRECIATE PEOPLE. I think it is the structure of the paradigm that causes the problem.”

The problem with therapy is not the therapist nor the method. The problem with therapy is therapy. It is inherent in the unnaturalness of the relationship itself and there is simply no way to ever get around this. The logical conclusion, once all other attempts at somehow fixing the problem have been exhausted, is to not enter into the relationship in the first place.

These “fixes,” incidentally, are akin to repeatedly repairing a building that is in fact so structurally unsound that it needs to simply be abolished.

I very seriously doubt that we are going to see the end of all the many forms of therapeutic relationships that currently exist any time soon (they in fact seem to be growing exponentially – man, we are a sick society) but sites such as this are invaluable at helping to chip away at the edifice.

I agree with all of this an am all too familiar with the damage that this profitable pseudoscience has done to my life, family and relationships. The fact that emotional abuse is carried out by these charlatans with the protection and endorsement of the medical profession and our own governments is appalling. It is a self regulated industry free of consequence for those who engage in it to be in positions where they can abuse and destroy fragile people. Unfortunately years ago, I was weak, I had the mistaken belief that psychotherapy was an industry backed by concrete science and studies, I didn’t even fully understand the unsubstantiated fiction that is the DSM. It is an industry fueled by profit, secrecy of it’s mistakes, irresponsibility and fraud, only backed and legally protected by government corruption and the pharmaceutical industry profiteering of a false science.

I spent from 18-34 in many different types of therapy from gestalt to rogerian to reichian to analytical trying to get help for family and self esteem problems. My issues should have been the bread and butter of therapy. Instead, none dealt with the issues. The first problem is that not one of 10 therapists took a detailed family history, so they did not know what was going on. Many therapists believe that just by listening to the words issuing from your mouth, they can completely tell what is happening. it’s total nonsense. Also, I was a victim of poor parental role modeling. Not one therapist ever talked about this or what healthy relationship was about. So I was left floundering. After 12 years of nothing, one therapist said “the older you get , the longer it takes.” To every question about when we were going to deal with my issues, the answer was “we’ll have to see how the therapy goes.” There were no plans, goals., nothing. These people are content with an opened ended therapy whose main goal is to keep the client in therapy as long as possible to get as much money as they can. this is the real goal. I did get myself straightened out later, but not thru a therapy process.

A while ago, we were in family therapy. I signed a permission form for him to speak to my therapist thinking it would be helpful. He went behind my back and told my therapist to convince me I should be drugged up for the “sake of my children.” There was no issue of abuse. I may not be the most skilled father, but who is. Since I was paying the fee, did he have any right to do that? My own therapist was deeply offended by this and said he had totally disrespected his long association with me. I would like someone’s view of this. Did he break a professional boundary. Should I have reported this behavior

Very sorry to hear about your family therapist’s betrayal. There aren’t many quality standards or consumer protections in the therapy industry; so “buyer beware” is the prevailing principle. Therefore, unless you were physically/sexually assaulted by your therapist, your complaint is, unfortunately, unlikely to be taken seriously.

The public, however, can and should take the issue of therapy harm seriously. There is currently ample “evidence to abandon ship.” In the meantime, I hope all readers will help to advocate for more transparency, informed consent, and consumer rights in the therapy industry.

Your blog posting is meaningful and awakening. I have been in and out of therapy and is currently with a therapist for 8 months. After, I believe I feel I have poured all of the marbles in a restricted room and continuing to develop trust, I am still confused wondering if I am recovering or not. Acceptance is very difficult concept to define. I am beginning to question the true purpose of therapy let alone realizing how therapists can be very friendly at the initial contact then backs out after a session to three sessions restricting all outside communications, deciding how to dedicate the relationship then constantly provide answers why they are doing it. I realized they are looking out for themselves first before the best interests of the clients then remind us it is all about us. When I hear the word, “It is all about you” can be very nerving at times since if they claimed if a client wants to improve all forms of relationship, a good place to start is with a therapist then why the relationship is a one way street that can harm a client thinking it can be an one way street outside of the office? How can a client learn if that is the expected relationship between a client and a therapist?

Thanks for your comment! It’s hard to see how a therapist could utter such paradoxes with a straight face: “It’s all about you — as long as it’s on my terms” or “Learn to improve relationships by learning to get comfortable with a subordinate role in an artificial one with asymmetrical power dynamics, one-sided intimacy, one person setting the terms and boundaries, where all communication happens on a timer, where large one-way payments are required, etc.” My goodness, imagine if you tried any of this with a friend! It sounds like a recipe for relationship destruction.

Try this, one of my issues was difficulty with relationships with women. I had poor parental role modeling and so didn’t have a clear picture of healthy male female relationships. I was with a male therapist for 12 years and he never dealt with this despite knowing this was important to me. When I finally confronted him with this, he said “Don’t you think you could learn about relationships with women by working on my relationship with him? Huh??? What am I supposed to do, tickle him under the chin, tease him, give a big wet kiss, feel his genitals??? There’s no comparison, it was total bullshit, and an excuse to try to keep me in therapy. I left at that session. I’m sure that most therapists try to put the same kind of nonsense on their clients. All I wanted was to be good with women. Why did this stump him??

I have a Ph.D, but not in psychology. Having tried therapy and having seen both the financial and emotional impact it has had on both me and others, I’m shocked at how wonky the entire therapeutic construct is. There doesn’t seem to be much of a unified theory about how the mind works, and each practitioner kind of makes up things as he or she goes along. They call it “eclectic.” I’m reminded of a line in Apocalypse Now about Colonel Kurtz: “‘Are you saying that his method is unsound?’ ‘I’m saying that there is no method at all.” The DSM is an absolute mess. Psychology kind of reminds me of phrenology. The other issue is the sheer amount of money changing hands here. Billions of dollars are poured down the psychological drain.

Personally, I’ve found Buddhist meditation to be helpful. It’s the core of CBT, and meditation isn’t really about talking about your problems, but about reframing them internally. It’s a lot of work to learn how to do it right. I’ve been studying for a year, and I’m just learning. It’s only 60 bucks a month for as many classes as I want to go to.

Interesting !! I was in therapy for 16 years with many therapists and found it to be worthless. Nobody addressed my issues and the whole thing was about money. I started to practice Buddhism in my 30s and transformed my life. No cost and profound concepts. More people should look at this.

I am so incredibly grateful for your article!!! It has taken me many months of tremendous agony to comprehend these points. You have summed it up so succinctly. I’ve spent a small fortune on Amazon trying to understand what went so terribly wrong in therapy. I have learned tonnnes about myself, emotional abuse, trauma bonds, personality disorders (due to the warped nature of the relationship dynamic: uncanny parallels!), indoctrination etc. But really, in the end I hope it’s more to do with the points made in your article… fallacious premise and inhumane practice. (Not comforting and not mutually exclusive). I am currently involved in a complaint resolution with the College of Physicians and Surgeons. I’m not expecting much, but am interested in seeing what they have to say. So far I have been dismissed and invalidated by at least four professionals. What century is this again???
Keep up the awesome work :)
~Eveline

Thanks for this interesting article. Therapy can be very destructive if the therapist is unhealthy! Many therapists go into this profession because of their own pain. I’ve just started blogging my experience with therapy gone bad, my day in court, and my feelings.

Thank you for this blog. I couldn’t agree more. I have a degree in psychology and completed a clinical internship but never got licensed. My experience from the inside was absolutely sickening and I abandoned the field. I thought it would be a meaningful career to help people deal with their problems, but what I found was a field full of some of the most disturbed and twisted people I have ever known. With few exceptions, the therapists I met had utter contempt for the clients (mostly poor Medicaid clients who were “mandated” into therapy by the courts, and once stuck in the spider web of diagnostic labels could never leave therapy). It is a dirty, disgusting industry. A total scam, with the government giving it a veneer of legitimacy by “licensing” the practitioners. More people should know the truth, especially the plight of the “mandated” client.

Beth, thanks so much for this comment, and sharing your experience! I agree that it is a dirty business, and I hope more policy makers come to recognize this before more and more people get sucked into the system. I really admire your courage and integrity in standing up for what’s right, and leaving the corrupt field behind. Thank you, again!